![]() The desire for a measuring device is old and various measurement methods for determining the torsion angle of the humerus can be found in the literature: anatomical, radiographic, with computed tomography (CT) or magnetic resonance imaging (MRI) and ultrasound measurements. Shoulder function in children is too variable and dependent on muscle tone to allow reliable conclusions concerning humeral torsion. There has been no simple clinical method of measuring humeral torsion deformity. CV not only causes poorly tolerated cosmetic deformity of the elbow but might also increase the risk of lateral condyle fractures, internal rotational malalignment, pain, malfunction of the elbow and other secondary fractures. Distal fragment malrotation may lead to instability, fragment tilt and subsequent varus of the elbow joint. In the majority of cases, CV is a combination of varus, hyperextension and internal rotation. Complications associated with supracondylar humeral fractures are not uncommon and include neurovascular lesions, reduced range of motion, compartment syndrome and cubitus varus (CV) deformity. Currently, the first choice of treatment is closed reduction and percutaneous crossed pin fixation, a surgical method with reliable biomechanical testing and low loss of reduction. ![]() Unstable and/or displaced fractures are usually treated by reduction and internal fixation. Several classifications focus on fracture stability versus instability and bone contact versus displacement. Diagnosis is based on clinical evaluation and conventional radiography. The majority of these fractures are extension-type ones as the result of falling on to the outstretched hand with the elbow extended. Supracondylar humeral fractures (SCHF) are the most common pediatric elbow fractures. This difference decreased within one year after trauma due to changes on the healthy side or correction in younger children with severe deformity. ConclusionĪfter displaced and surgically treated SCHF, most children had humeral torsion differences of both arms. The most significant correction of posttraumatic humeral torsion occurred in children 20°. During follow-up, an average decrease of the difference from 14° (six weeks) to 7.8° (four months) to 6.5° (six months) and to 4.9° (twelve months) was observed. Of those, 44% showed a rotational spur, slight valgus or varus on radiographs. Six weeks after trauma, 67% of SCHF children had a sonographically detected humeral torsion difference of > 5° (average 14.0 ± 7.6°). Differences in shoulder and elbow motion, elbow axis, sonographic humeral torsion measurement and radiological evaluation focusing on rotational spur were administered. Clinical, photographic, sonographic and radiological data were obtained regularly. MethodsĪ cohort of 27 children with displaced and surgically treated SCHF were followed prospectively from the diagnosis until twelve months after trauma. The aim of this study was to evaluate the incidence of humeral torsion differences in children with surgically treated SCHF and to observe spontaneous changes over time. Detection and assessment of malrotation is difficult and the fate of post-traumatic humeral torsion deformity is unknown. Distal fragment malrotation may lead to instability, fragment tilt and subsequent CV. After displaced supracondylar humerus fractures (SCHF) in children, residual deformities are common with cubitus varus (CV) being the clinically most visible.
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